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Tc-99m PMT scintigraphy in the diagnosis of pediatric biliary atresia

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Abstract

Purpose

Hepatobiliary scintigraphy plays an important role in the differentiation of biliary atresia (BA) and non-BA. The usefulness of 99mTc-iminodiacetic acid (IDA) derivatives in BA diagnosis is reported in several papers. In contrast, there are no comprehensive data on differentiating BA from non-BA using 99mTc-N-pyridoxyl-5-methyl-tryptophan (PMT). Our objective was to evaluate the usefulness of 99mTc-PMT scintigraphy in the diagnosis of BA.

Materials and methods

52 infants who received 99mTc-PMT scintigraphy for suspected BA were retrospectively evaluated. Preoperative cholangiograms or follow-ups were used as the gold standard for diagnosis of BA. We analyzed the utility of 99mTc-PMT scintigraphy, various clinical and investigational parameters in the diagnosis of BA.

Results

The final diagnoses in this group were BA (67.3%) and non-BA (32.7%). 99mTc-PMT scintigraphy, stool color change, total bilirubin, direct bilirubin, aspartate aminotransferase (AST) and γ-glutamyl transferase (γ-GTP) led to distinguishing between BA and non-BA in univariate analysis. Subsequent multivariate logistic regression analysis indicated that 99mTc-PMT scintigraphy and γ-GTP were independent predictors of BA. The diagnostic accuracy of 99mTc-PMT scintigraphy was 94.2%.

Conclusions

99mTc-PMT scintigraphy is more accurate in the diagnosis of BA than other conventional examinations. In addition, false positives of 99mTc-PMT scintigraphy could be reduced by combining γ-GTP level monitoring.

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Abbreviations

BA:

Biliary atresia

PMT:

N-Pyridoxyl-5-methyl-tryptophan

IDA:

Iminodiacetic acid

LEHR:

Low-energy high resolution

LMEGP:

Low-medium energy general purpose

ROC:

Receiver-operating characteristic

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

γ-GTP:

γ-Glutamyl transferase

ALP:

Alkaline phosphatase

AUC:

Area under the receiver-operating characteristic curve

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Acknowledgements

Ryuji Ikeda provided invaluable assistance in the performance of 99mTc-PMT scintigraphy.

Funding

This study was not funded by any institution.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Noriko Tsuda, Shinya Shiraishi, Fumi Sakamoto, Koji Ogasawara & Yasuyuki Yamashita

  2. Department of Diagnostic Medical Imaging, School of Health Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

    Seiji Tomiguchi

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  1. Noriko Tsuda
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  2. Shinya Shiraishi
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  3. Fumi Sakamoto
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  4. Koji Ogasawara
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Correspondence to Noriko Tsuda.

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The authors declare that they have no conflict of interest.

Ethical statement

This study was approved by Kumamoto University institutional ethics board. All study procedures were in accordance with the Statement of Human and Animal Rights. Prior informed consent for inclusion in the study was obtained from all patients by their legal representatives.

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Tsuda, N., Shiraishi, S., Sakamoto, F. et al. Tc-99m PMT scintigraphy in the diagnosis of pediatric biliary atresia. Jpn J Radiol 37, 841–849 (2019). https://doi.org/10.1007/s11604-019-00882-8

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  • DOI: https://doi.org/10.1007/s11604-019-00882-8

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